HPV the hidden danger – Deborah Lyle

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  Posted by: The Probe      16th November 2018

Oral cancer is the sixth most common cancer and is responsible for around 4,000 deaths in the UK annually.[i]Risk factors for oral cancer include: alcohol, tobacco, the human papillomavirus (HPV), areca nut chewing (aka paan), drinking Maté (a drink made from yerba mate), radiation and genetic factors.[ii],[iii]Chronic trauma in the oral cavity may amplify the risk posed by the aforementioned, but is not thought to be an independent cause.[iv]Drinking Maté, chewing tobacco or the areca nut are rare habits in the UK, and may be a factor in the relatively low prevalence of the disease here. However, while historically not as common as in other regions, the incidence rate of oral cancer rose more than 30% between 1990 and 2006, reaching 13 cases per 100,000 by 2014.[v],[vi]Men are at moderately greater risk than women of developing oral cancer, accounting for 60% of cases.[vii]More recently, research has found a greater risk of oral cancer among those with diabetes.[viii]

With smoking rates steadily declining, the rise in younger men developing oral cancers is increasingly believed to be due to HPV infections. HPV is transmitted sexually and the infection generally stays localised, so the primary vector for this is oral sex. There are more than 150 strains of HPV and infection is very common. In most cases the infection is innocuous, often not resulting in any symptoms whatsoever, or relatively trivial symptoms like genital warts. However, 15 different HPV strains have been identified that increase the risk of developing oral cancer.

One bit of good news is that the survival rate for oral cancers caused by HPV is significantly higher than those with other causes.[ix]This is due to HPV-positive oral cancers responding more favourably to existing treatments than HPV-negative ones.[x]Overall, HPV-positive patients are 7% more likely to survive the first year, and 33% more likely to survive two years. Furthermore, in HPV-positive cases, the disease is significantly less likely to progress once treatment has begun compared to –negative (a difference of 22% in the first year).[xi]Unfortunately this is somewhat offset by the fact that these are often more difficult to detect in the early stages, particularly if originating in the deeper recesses of the mouth (such as at the base of the tongue), which are less visible and will not necessarily manifest the classic hallmarks of lesions and discolouration.

The UK introduced an immunisation programme for girls aged 12-18 in September 2008, which protects against HPV types 16 and 18 (later recipients received protection against types 6 and 11 as well). This was brought in to combat cervical cancer, as these two strains have proven to be responsible for more than 70% of cases.[xii]HPV 16 is regarded as by far the most high-risk strain and is thought to be the main driver of HPV related oral cancers.[xiii]This would suggest that the vaccination programme will have the added benefit of protecting against oral cancer, though the efficacy of this is not yet fully conclusive.[xiv]While immunising females offers some cross-protection to males, it was eventually recognised that this did not extend to men who have sex with men or some transgender people. As a result, from April 2018, HPV vaccines were available to people in these demographics on the NHS up to the age of 45 via GUM (genitourinary medicine) clinics and HIV clinics in England.

Since the UK’s original programme was introduced ten years ago, the evidence of links between HPV and non-cervical cancers has increased substantially. This in conjunction with the prospect of more effective herd immunity and a more favourable cost-benefit analysis has prompted a change in policy and the Department of Health and Social Care has announced that males aged 12-13 will now also receive a vaccination against HPV in the near future.[xv],[xvi]

As with any cancer, early detection is crucial for improving survivability. If caught near the outset, mouth cancer can be treated with surgery alone in nine out of ten cases within the NHS.[xvii]Catching the disease before it metastasises makes treatment simpler and greatly increases the odds of survival. Four out of five patients survive stage 1 and 2 oral cancer for at least 3 years. This drops to just one in two when the disease reaches stage 3 or 4.[xviii]

 

Oral side effects are common in patients undergoing treatment for cancer, oral and otherwise. These include mouth infections, dry mouth, bleeding, increased susceptibility to infection, mucositis and many other ailments. Adequately cleaning the mouth while under the effects of chemotherapy or radiotherapy is important, but can unfortunately prove painful.[xix]

For patients in these circumstances and others, the Waterpik®Ultra Professional Water Flosser could prove invaluable. Offering a floss mode that is more effective than traditional dental floss or interdental brushes, yet comfortable and easy to use.[xx],[xxi]

Regular dental check ups are a key battleground in the fight against oral cancer. Many patients are unlikely to notice early warning signs themselves, making the professional eye an indispensible asset on the frontline. Alarmingly, in a survey of British GPs 97% claimed they received no training for oral cancer, with few conducting screening as a result.[xxii]It falls to dental professionals to offer this potentially life saving service. Why not use this year’s Mouth Cancer Action Month to spread the word?

 

For more information on Waterpik®please visit www.waterpik.co.uk.
Waterpik®products are available from Amazon, Asda, Costco UK, Boots.com, ASDA stores and Superdrug stores across the UK and Ireland.

 

 

REFERENCES
[i]Cancer Research UK. Head and neck cancers statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers[Accessed August 2018]
[ii]Sankaranarayanan R., Ramadas K., Amarasinghe H. Chapter 5 Oral cancer: prevention, early detection, and treatment. Gelband H., Jha P., Sankaranarayanan R., Horton S. (ed.) Cancer: Disease Control Priorities, Third Edition (Vol. 3). Washington, DC: The International Bank for Reconstruction and Development / The World Bank. 2015. Available at: https://www.ncbi.nlm.nih.gov/books/NBK343649/Accessed August 2, 2018.
[iii]Kumar M., Nanavati R., Modi T., Dobariya C. Oral cancer: etiology and risk factors: a review. Journal of Cancer Research and Therapeutics. 2016; 12(2): 458-463. Available at http://www.cancerjournal.net/text.asp?2016/12/2/458/186696Accessed August 2, 2018.
[iv]Sankaranarayanan R., Ramadas K., Amarasinghe H. Chapter 5 Oral cancer: prevention, early detection, and treatment. Gelband H., Jha P., Sankaranarayanan R., HortonS. (ed.) Cancer: Disease Control Priorities, Third Edition (Vol. 3). Washington, DC: The International Bank for Reconstruction and Development / The World Bank. 2015. Available at: https://www.ncbi.nlm.nih.gov/books/NBK343649/Accessed August 2, 2018.
[v]Oxford Cancer Intelligence Unit (OCIU) & The National Cancer Intelligence Network(NCIN) Head and Neck Cancers Site Specific Clinical Reference Group. Profile of head and neck cancers in England: incidence, mortality and survival. NHS. 2010. Available at http://www.ncin.org.uk/view?rid=69Accessed August 2, 2018.
[vi]Mouth cancer rates soar over 20 years. Cancer Research UK. 2016. Available at https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2016-11-25-mouth-cancer-rates-soar-over-20-yearsAccessed August 2, 2018.
[vii]NCIN. Oral cavity cancer: recent survival trends. National Cancer Registration and Analysis Service. 2013. Available at http://www.ncin.org.uk/publications/data_briefings/oral_cavity_cancer_recent_survival_trendsAccessed August 2, 2018.
[viii]Ohkuma, T., Peters, S.A.E. & Woodward, M. Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events
Diabetologia (2018). https://doi.org/10.1007/s00125-018-4664-5Accessed 2, August 2018.
[ix]Gillison M., Koch W., Capone R., Spafford M., Westra W., Wu L., Zahurak M., Daniel R., Viglione M., Symer D., Shah K., Sidransky D. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. Journal of the National Cancer Institute. 2000; 92(2): 709-720. Available at https://academic.oup.com/jnci/article/92/9/709/2906131Accessed August 2, 2018.
[x]Kian Ang K., Harris J., Wheeler R., Weber R., Rosenthal D., Nguyen-Tân P., Westra W., Chung C., Jordan R., Lu C., Kim H., Axelrod R., Silverman C., Redmond K., Gillison M. Human papillomavirus and survival of patients with oropharyngeal cancer. The New England Journal of Medicine. 2010; 363: 24-35. https://www.nejm.org/doi/full/10.1056/NEJMoa0912217Accessed August 2, 2018.
[xi]Fakhry C. Westra W., Sigui L., Cmelak A., Ridge J., Pinto H., Forastiere A., Gillison M. Improved Survival of Patients With Human Papillomavirus–Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial 
 Journal of the National Cancer Institute. 2008; 4(20): 261-269. Available at https://academic.oup.com/jnci/article/100/4/261/908311Accessed August 2, 2018.
[xii]Hilton S., Hunt K., Langan M., Bedford H., Petticrew M. Newsprint media representations of the introduction of the HPV vaccination programme for cervical cancer prevention in the UK (2005-2008). Social Science & Medicine. 2010; 70(6): 942-950. Available at https://www.sciencedirect.com/science/article/pii/S0277953609008417Accessed August 2, 2018.
[xiii]Sugiyama M., Bhawal U., Dohmen T., Ono S., Miyauchi M., Ishikawa T. Detection of human papillomavirus-16 and HPV-18 DNA in normal, dysplastic and malignant oral epithelium. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2003; 95(5): 594-600. Available at https://www.sciencedirect.com/science/article/pii/S1079210402916379Accessed August 2, 2018.
[xiv]Kim S. Human papilloma virus in oral cancer. Journal of the Korean Association of Oral and Maxillofacial Surgeons.2016; 42(6): 327-336.  Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206237/Accessed August 2, 2018.
[xv]Joint Committee on Vaccination and Immunisation. Statement on HPV vaccination. GOV.UK. 2018. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/726319/JCVI_Statement_on_HPV_vaccination_2018.pdfAccessed August 2, 2018.
[xvi]Department of Health and Social Care. HPV vaccine to be given to boys in England. GOV.UK. 2018. Available at https://www.gov.uk/government/news/hpv-vaccine-to-be-given-to-boys-in-englandAccessed August 2, 2018.
[xvii]Mouth cancer NHS Choices. 2016. Available at https://www.nhs.uk/conditions/mouth-cancer/Accessed August 2, 2018.
[xviii]Mouth and oropharyngeal cancer: survival. Cancer Research UK. Available at https://www.cancerresearchuk.org/about-cancer/mouth-cancer/survivalAccessed August 2, 2018.
[xix]Rapone B., Nardi G., Venere D., Pettini F., Grassi F., Corsalini M. Oral hygiene in patients with oral cancer undergoing chemotherapy and/or radiotherapy after prosthesis rehabilitation: protocol proposal. Oral & Implantology. 2016; 9(Suppl. 1): 90-97. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333751/Accessed August 2, 2018.
[xx]Goyal CR, Lyle DM, Qaqish JG, Schuller R. Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. Journal of Clinical Dentistry. 2016; 27: 61-65. Available at https://www.waterpik.co.uk/professional/clinical-research/pdfs/effectiveness-water-flosser-vs-interdental-brushes.pdfAccessed August 2, 2018.
[xxi]Barnes CM1, Russell CMReinhardt RAPayne JBLyle DM. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005;16(3):71-7. https://www.ncbi.nlm.nih.gov/pubmed/16305005Accessed August 2, 2018.
[xxii]Wade J., Smith H., Hankins M., Llewellyn C. Conducting oral examinations for cancer in general practice: what are the barriers. Family Practice. 2010; 1(1): 77-84. Available at https://academic.oup.com/fampra/article/27/1/77/477891Accessed August 2, 2018.


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